# P-1407. Beyond the Patient: Educational Disruption and Household Poverty in the Wake of Tuberculosis

## TL;DR

This study shows that tuberculosis not only affects patients but also disrupts education and increases poverty in their households, especially in India.

## Contribution

The study highlights the socioeconomic impact of TB, emphasizing the link between education disruption and household poverty.

## Key findings

- 14% of households reported educational disruption, mostly affecting household contacts of TB patients.
- Households with education disruption had fluctuating income and higher poverty scores compared to those without disruption.
- Each year of schooling lost due to TB reduces lifetime earnings by about 8%.

## Abstract

Tuberculosis (TB), a leading cause of global mortality, disproportionately affects low socioeconomic households and deepens poverty. In India, persons with TB (PWTB) and their families face disrupted education and reduced income, further limiting access to care. TB must be recognized not just as a clinical condition but as a social disease—intertwined with education, nutrition, and economic stability—if elimination goals are to be met.

Household Income Over Course of Treatment by Education Discontinuation StatusFigure 1.Comparison of household income over course of TB treatment between households that have at least one individual who experienced educational disruption versus the control group.Multidimensional Poverty Index Score Comparison Based on Education StatusFigure 2.Comparison of Multidimensional Poverty Index score between households that have at least one individual who experienced interrupted schooling

Comparison of household income over course of TB treatment between households that have at least one individual who experienced educational disruption versus the control group.

Multidimensional Poverty Index Score Comparison Based on Education Status

Comparison of Multidimensional Poverty Index score between households that have at least one individual who experienced interrupted schooling

We used data from the RePORT India cohort, which follows PWTB in Puducherry, Tamil Nadu, Maharashtra, and Telangana. Participants were assessed at baseline; months 1 and 2 (intensive phase); month 6 (treatment completion); and at 6 and 12 months post-treatment. Clinical data included symptoms, treatment history, BMI, and Karnofsky scores. Structured interviews assessed TB’s socioeconomic effects using the Multidimensional Poverty Index (MPI), which includes education, living standards, and household composition.

Among 663 households surveyed, 14% reported disrupted education, 85% of which involved household contacts of PWTB. Disruption often affected multiple members; 26 unique households reported educational interruption. Households without disruption showed steady income gains between months 2 and 6 post-treatment, while those with disruption exhibited fluctuating income, suggesting prolonged vulnerability. MPI scores averaged 38.4 in disrupted households vs. 30.8 in others (poverty threshold: 33).

TB’s impact extends beyond the patient, disrupting education and eroding household resilience. Each missed year of schooling reduces lifetime earnings by ∼8%. Protecting education during TB illness is critical to achieving household stability and national TB elimination targets.

Robert C. Bollinger, Jr., MD, MPH, [SCENE] Health: Advisor/Consultant|[SCENE] Health: Board Member|[SCENE] Health: Stocks/Bonds (Private Company)|Merck: Advisor/Consultant|miDiagnostics: Co-inventor of IP owned by Johns Hopkins University|miDiagnostics: Eligible for equity and royalty payments received by Johns Hopkins University